Provider Demographics
NPI:1477643088
Name:MARTIN, TRISCIA (PA)
Entity Type:Individual
Prefix:
First Name:TRISCIA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 EASTERN AVE
Mailing Address - Street 2:MFL WEST TOWER, 6TH FLR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-2734
Mailing Address - Country:US
Mailing Address - Phone:415-550-5018
Mailing Address - Fax:
Practice Address - Street 1:5200 EASTERN AVE
Practice Address - Street 2:MFL WEST TOWER, 6TH FLR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-2734
Practice Address - Country:US
Practice Address - Phone:410-550-5018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2011-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6033775-1206363A00000X
MDC0004046363AM0700X
DCPA030646363AM0700X
NY009695363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD19003Y82Medicare PIN